急性颅脑损伤患者心率变异性的动态变化及其意义  

Dynamic changes and signiflcance of heart rate variability in acute brain injury patients

作　　者：单凯[1] 林晖[1] 杜凤和[1] 

机构地区：[1]首都医科大学附属北京天坛医院心血管内科,北京100050

出　　处：《中国急救医学》2006年第11期801-803,共3页Chinese Journal of Critical Care Medicine

基　　金：首都医学发展科研基金(No.2002-2025)

摘　　要：目的研究急性颅脑损伤患者伤后不同时相心率变异性(HRV)的动态变化及其意义。方法选择146例急性颅脑损伤患者作为试验组,入院即刻行动态心电图(AECG)检查。急性颅脑损伤组入院后5 d仍存活的132例患者行再次AECG检查。另选择120例性别和年龄相仿的健康者作为对照组接受AECC检查。对三组HRV的时域和频域结果进行分析。结果与对照组相比,急性颅脑损伤患者入院即刻平均正常R-R间期标准差(SDNN)、每5 min正常R-R间期标准差的平均值(SDANN index)、相邻R-R间期差的均方根(RMSSD)、相邻R-R间期之差＞50 ms的心搏数占R-R间期总教的百分比(PNN50)、低频段功率(LF)及高频段功率(HF)等指标明显降低(P均＜0．01),入院后5 d组患者RMSSD、PNN50、LF、HF、SDNN、SDANN index也明显降低(P均＜0．01)。入院后5 d组患者所有HRV指标明显恢复,与自身入院即刻检查结果相比差异有统计学意义(P均＜0．01)。结论急性颅脑损伤患者伤后早期HRV明显下降,且维持时间较长,是伤后较为敏感的监测指标。Objective To explore the dynamic changes and significance of heart rate variability （HRV） in acute brain injury patients. Methods 146 acute brain injury patients were selected as experimental group and underwent ambulatory electrocardiogram （AECG） immediately after hospitalization. 132 patients who were still alive on the 5th day ＇after admission, underwent AECG again. 120 sex and age - matched normal individuals were used as control gmup. HRV of three groups was assessed in both time and frequency domains. Results Compared with control group, the standard deviation of all normal R - R intervals （ SDNN ） , the mean of the standard deviations of the average of R - R intervals （ SDANN index ） , the root mean square for successive interval differences （RMSSD） ,the percentage of delta of R - R interval of more than 50 ms（PNN50） ,low - frequency（LF） and high - frequency power （HF） of immediately admission group decreased significantly（ P 〈0.01） ; the HRV of 5 -day admission group also experienced a significant decrease（ P 〈 0.01）. All the parameters of 5 -day admission group showed a obvious recovery,and the difference between the initial and final parameters of 5 - day admission group was significant in statistics （ P 〈 0.01 ）. Conclusion The HRV of acute brain injury patients decreased significantly during the earlier period, and lasted for a long time. It can be used as a sensitive marker for acuteLIN Hui, brain injury monitoring.

关 键 词：急性颅脑损伤 心率变异性 自主神经系统 

分 类 号：R651.15[医药卫生—外科学]